PURPOSE: This rule specifies the criteria necessary for registered professional nurses to be recognized by the Missouri State Board of Nursing and therefore eligible to practice as advanced practice nurses and use certain advanced practice nurse titles.

1. (1) Definitions.

   1. (A) Accredited college or university—An institution of learning awarded accreditation status by the appropriate regional accreditation body for higher education certified by the Council on Post Secondary Accreditation to conduct such accreditations.

   2. (B) Advanced nursing education program—

      1. 1. Prior to July 1, 1998, completion of

a formal postbasic educational program from or formally affiliated with an accredited college, university, or hospital of at least one (1) academic year, which includes advanced nursing theory and clinical nursing practice, leading to a graduate degree or certificate with a concentration in an advanced practice nursing clinical specialty area.

1. 2. From and after July 1, 1998, comple-

tion of a graduate degree from an accredited college or university with a concentration in an advanced practice nursing clinical specialty FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION

area, which includes advanced nursing theory and clinical nursing practice.

1. (C) Advanced practice nurse—A registered professional nurse as defined in section 335.016(2), RSMo and who is a nurse anesthetist, nurse midwife, nurse practitioner, or clinical nurse specialist.
2. (D) Advanced practice nursing clinical specialty—Recognized advanced body of nursing knowledge and specialized acts of advanced professional nursing practice.
3. (E) Nationally recognized certifying body—An entity endorsed by a nationally recognized professional nursing organization acceptable to the Missouri State Board of Nursing which, through formal and ongoing processes of evaluation and verification, certifies that a licensed registered professional nurse has met predetermined professional nursing practice standards in an advanced practice nursing clinical specialty area and which meets the criteria specified in section

1. (6) of this rule.

   1. (F) Nationally recognized professional nursing organization—A membership entity for registered professional nurses in the United States whose intention is national in scope and exists, in part, for the ongoing purposes of—

      1. 1. Fostering high standards for profes-

sional nursing practice;

1. 2. Promoting the professional develop-

ment and general welfare of registered professional nurses;

1. 3. Improving the health and well-being

of individuals, families, and communities in collaboration with other health care providers; and

1. 4. Engaging in action at the national

level on matters of professional policy and national health policy.

1. (2) Eligibility Criteria for Nurses with Specialty Certification.

   1. (A) Registered professional nurses who are certified registered nurse anesthetists, certified nurse midwives, certified nurse practitioners, or certified clinical nurse specialists applying for recognition from the Missouri State Board of Nursing for eligibility to practice as advanced practice nurses shall—

      1. 1. Hold current license to practice in

Missouri as registered professional nurses; and

1. 2. Be certified in their respective

advanced practice nursing clinical specialty area by a nationally recognized certifying body, meeting the requirements of this rule; and

1. 3. Submit documented evidence of satis-

factory, active, up-to-date certification/recertification/maintenance and continuing education/competency to the board.

1. (3) Eligibility Criteria for Nurses Without Specialty Certification.

   1. (A) Registered professional nurses for whom no advanced practice nursing clinical specialty certification from a nationally recognized certifying body is available applying for recognition from the Missouri State Board of Nursing for eligibility to practice as advanced practice nurses shall—

      1. 1. Hold current license to practice in

Missouri as registered professional nurses; and

1. 2. Demonstrate their education, train-

ing, and experience to practice advanced practice nursing by—

1. A. Providing evidence of having suc-

cessfully completed an advanced nursing education program as defined in subsection (1)(B); and

1. B. Submitting evidence of successful

completion of three (3) graduate credit hours of pharmacology offered by an accredited college or university within the previous five (5) years prior to date of application to the board; and

1. C. Submitting evidence of a minimum

of fifteen hundred (1,500) hours of clinical practice in the advanced practice nursing clinical specialty area within the previous two (2) years prior to date of application to the board; and

1. 3. Subsection (3)(A) does not apply to

those registered professional nurses for whom a board-accepted nationally recognized advanced practice nursing clinical specialty area certification examination exists or is available.

1. (B) A person who has graduated from an advanced nursing education program may be recognized by the Missouri State Board of Nursing as a Graduate Advanced Practice Registered Nurse for up to four (4) months from the date of graduation, pending a certification decision by an acceptable nationally recognized certifying body, upon satisfactory proof that they:

   1. 1. Hold current license to practice in

Missouri as registered professional nurses; and

1. 2. Provide evidence of having success-

fully completed an advanced nursing education program as defined in subsection (1)(B); and

1. 3. Have applied for certification with an

acceptable nationally recognized certifying body;

1. 4. Have never been denied certification,

or had any certification suspended, revoked or cancelled, by an acceptable nationally recognized certifying body; and

1. 5. They agree to:

   1. A. Cease advanced practice nursing

immediately upon notice that they have not successfully completed the certification process for any reason; and

1. B. Notify the board within five (5)

working days of the receipt of the results of their certification application.

1. (C) Subsection (3)(B) applies only to graduate registered professional nurses for whom a board-accepted nationally recognized advanced practice nursing clinical specialty area certification examination exists or is available.

1. (4) Titling.

   1. (A) After June 30, 1997, only a registered professional nurse meeting the requirements of this rule and recognized by the Missouri State Board of Nursing as an advanced practice nurse shall have the right to use any of the following titles or their abbreviations in clinical practice: advanced practice nurse, certified advanced practice nurse, nurse anesthetist, certified registered nurse anesthetist, nurse midwife, certified nurse midwife, nurse practitioner, certified nurse practitioner, clinical nurse specialist, or certified clinical nurse specialist.
   2. (B) Registered professional nurses recognized as advanced practice nurses by the Missouri State Board of Nursing shall specify their registered professional nurse title, clinical nursing specialty area designation, and certification status, if applicable, for purposes of identification and documentation. Advanced practice nurses will be held accountable by the board for representing themselves accurately and fully to the public, their employers, and other health care providers.

2. (5) Scope of Practice.

   1. (A) Registered professional nurses recognized by the Missouri State Board of Nursing as being eligible to practice as advanced practice nurses shall function clinically—

      1. 1. Within the state of Missouri Nursing

Practice Act, Chapter 335, RSMo, and all other applicable rules and regulations; and

1. 2. Within the professional scope and

standards of their advanced practice nursing clinical specialty area and consistent with their formal advanced nursing education and national certification, if applicable, or within their education, training, knowledge, judgement, skill, and competence as registered professional nurses.

1. (6) Certifying Body Criteria.

   1. (A) In order to be a certifying body acceptable to the State Board of Nursing for advanced practice nurse status, the certifying body must meet the following criteria—

      1. 1. Be national in the scope of its cre-

dentialing;

1. 2. Have no requirement for an applicant

to be a member of any organization;

1. 3. Have formal requirements that are

consistent with the requirements of 20 CSR 2200-4.100 Advanced Practice Nurse rule;

1. 4. Have an application process and cre-

dential review that includes documentation that the applicant’s advanced nursing education, which included theory and practice, is in the advanced practice nursing clinical specialty area being considered for certification;

1. 5. Use psychometrically sound and

secure examination instruments based on the scope of practice of the advanced practice nursing clinical specialty area;

1. 6. Issue certification based on passing

examination and meeting all other certification requirements;

1. 7. Provide for periodic recertifica-

tion/maintenance options which include review of qualifications and continued competence; and

1. 8. Have an evaluation process to pro-

vide quality assurance in its certification, recertification, and continuing competency components.

1. (B) Each listed certifying body and/or its policies and procedures for certification shall be subject to at least annual review by the Missouri State Board of Nursing to determine whether criteria for recognition under this rule are being maintained.
2. (C) The Missouri State Board of Nursing shall identify, keep on file, and make available to the public the current list of nationally recognized certifying bodies acceptable to the board of nursing. Nationally recognized certifying bodies may be added or deleted from the board of nursing’s list of nationally recognized certifying bodies based on the criteria set forth in this rule. A copy of the current list can be obtained by contacting the Missouri State Board of Nursing, PO Box 656, Jefferson City, MO 65102 or by calling

1. (573) 751-0681.

2. (7) Application for Recognition.

   1. (A) After June 30, 1997, the Missouri State Board of Nursing shall maintain an upto-date roster of registered professional nurses recognized as eligible to practice as advanced practice nurses, which shall be available to the public. A copy of the current roster can be obtained by contacting the Missouri State Board of Nursing, PO Box 656, Jefferson City, MO 65102 or by calling (573) 751-0681.
   2. (B) Registered professional nurses seeking recognition as eligible to practice as advanced practice nurses shall complete and submit an application form, application fee, and all required evidence specified in this rule to the Missouri State Board of Nursing, PO Box 656, Jefferson City, MO 65102. Incomplete application forms and evidence will be considered invalid. Fees are not refundable.

   3. (C) Notwithstanding the provisions of section (2), registered professional nurses seeking licensure by endorsement and recognition as advanced practice nurses in Missouri may receive such recognition under section (2) if—

      1. 1. Prior to July 1, 1998, they had com-

pleted a formal postbasic education program from or formally affiliated with an accredited college, university, or hospital, of at least one (1) academic year, which included advanced nursing theory and clinical nursing practice, leading to a graduate degree or a certificate with a concentration in an advanced practice nursing clinical specialty area; and

1. 2. Prior to July 1, 1998, they were cer-

tified by a nationally recognized certifying body acceptable to the Missouri State Board of Nursing and have continuously maintained active, up-to-date recertification status.

1. (8) Continued Recognition.

   1. (A) Advanced practice nurses who place their registered professional nurse licenses on inactive status or allow their registered professional nurse licenses to lapse shall lose recognition as advanced practice nurses in Missouri.
   2. (B) Advanced practice nurses shall notify the board within five (5) working days of any change in status, documentation, or other changes that may affect their continued recognition as advanced practice nurses.
   3. (C) Certified advanced practice nurses shall maintain active, up-to-date recertification status and continuing competency in advanced practice nursing clinical specialty area by actively participating and satisfactorily meeting recertification/maintenance terms and/or continuing education/competency requirements of their nationally recognized certifying body. It is the responsibility of certified advanced practice nurses to submit evidence to the board of active, satisfactory recertification and continuing education/competency prior to expiration date to prevent removal of recognition as advanced practice nurses by the Missouri State Board of Nursing.
   4. (D) Noncertified advanced practice nurses recognized by the Missouri State Board of 20 CSR 2200-4

Nursing as being eligible to practice as advanced practice nurses pursuant to subsection (3)(A) shall, within every two (2) years following recognition by the board, submit documented evidence of—

1. 1. A minimum of fifteen hundred

(1,500) hours of clinical practice in their advanced practice nursing clinical specialty area; and

1. 2. A minimum of twenty (20) contact

hours in their advanced practice nursing clinical specialty area offered by an accredited college or university.

1. (E) Advanced practice nurses who fail to satisfy any of the applicable requirements of subsections (8)(A)–(D) shall lose their recognition as an advanced practice nurse. Loss of recognition as an advanced practice nurse results in ineligibility to call oneself or practice as an advanced practice nurse, but does not prevent the individual from practicing as a registered professional nurse within his/her education, training, knowledge, judgement, skill, and competence. To regain recognition as an advanced practice nurse the individual must complete the application process described in section (7) of this rule.

AUTHORITY: sections 335.016(2) and 335.036, RSMo Supp. 2007.* This rule originally filed as 4 CSR 200-4.100. Original rule filed Nov. 15, 1991, effective March 9, 1992. Rescinded and readopted: Filed Oct. 25, 1995, effective June 30, 1996. Emergency amendment filed May 1, 1997, effective May 12, 1997, expired Nov. 7, 1997. Amended: Filed May 1, 1997, effective Oct. 30, 1997. Amended: Filed June 16, 2003, effective Dec. 30, 2003. Moved to 20 CSR 2200-4.100, effective Aug. 28, 2006. Amended: Filed Aug. 11, 2006, effective March 30, 2007. Amended: Filed June 27, 2008, effective Dec. 30, 2008. *Original authority: 335.016(2), RSMo 1975, amended 1993, 1995, 1999, 2002, 2004, 2007 and 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007.